A detailed medical history is the cornerstone for accurate patient assessments and medical diagnosis. Traditional history taking by clinicians is often incomplete and time consuming because it requires not only collecting the information, but also accurately documenting it. Clinicians are typically highly paid medical professionals. A need exists, therefore, for a system that can take an accurate and complete medical history without the direct participation of costly medical personnel.
Computerized systems are available for patients to enter medical data themselves in response to queries. Typically, these systems use a predetermined set of questions for the patient, or another user on behalf of the patient, to answer. These computerized systems are considered superior to traditional history taking techniques because typically such systems 1) are highly structured to include all pertinent questions and never forget to ask a question; 2) can be done at the patient's pace at a time and place that is convenient for the patient; 3) elicit sensitive information that is often underreported in the face-to-face interview; 4) can be administered in different languages; 5) prepare patients for the subsequent encounter with the clinician; 6) can calculate scores to clinical rating scales for easy interpretation by a physician; and 7) provide legible summaries that can be manipulated by or directly entered into an electronic medical record.
A known automated computer-based medical history taking system is described in U.S. Pat. No. 3,566,370 which provides for the development of and printout of a patient's medical history. The system includes a display for presenting questions with multiple choice answers to a patient. Subsequent questions are presented to the patient in accordance with the answers to previous questions. Therefore, medically related questions are automatically propounded according to U.S. Pat. No. 3,566,370, even though not specifically selected for review by a patient.
Similarly, U.S. Pat. No. 7,290,016 describes a system and method for generating and storing a medical history that uses a questionnaire database in which answers to questions are correlated with subsequent questions. The questionnaire database includes a plurality of questions and corresponding multiple choice responses. The responses are associated with additional questions in the questionnaire database. Therefore, the pattern through the questionnaire database is not predetermined according to U.S. Pat. No. 7,290,016, but is dependent upon the pattern of answers.
While both of the above-mentioned systems and methods for eliciting a medical history are superior to traditional history taking techniques, i.e., by a clinician or paper questionnaire, these and other known systems and methods still have serious drawbacks that limit their effectiveness and have hindered their widespread acceptance by both patients and the medical community at large.
First, these known computer based questionnaires contain too many questions, many of which are not relevant to the patient being asked the question, i.e., many questions are not patient specific. While known systems do employ branch-chain logic to hone in on specific patient complaints and clarify symptoms, these systems have no way of identifying which questions are the most important to ask the patient upfront. As such, these known systems require the patients to answer too many irrelevant questions. Furthermore, patients make inadvertent errors during standard computer interviews of these known systems because the patients misunderstand the questions, forget, and/or become tired and careless. Studies such as noted by Carr have found that these drawbacks lead to an error rate in patient directed computer interviews of 3%-7%.
There is a need, therefore, for a patient-driven computer based system that is not only highly patient specific, but also provides a “checks and balance” system for the patient to help eliminate some of the errors that occur from patients misunderstanding questions and/or forgetting or inadvertently misrepresenting certain components of their medical history. There is also a need for the system to learn from both the patient's particular situation and from the system's experience with prior users in order to provide more relevant questions to the patient in order to more readily obtain a more accurate medical history from the patient.